Resting energy expenditure (REE) estimation is crucial in critically ill patients. While indirect calorimetry (IC) is the gold standard, its limited availability often necessitates alternative methods. In this exploratory study, we compared the accuracy of the stress factor-corrected Harris-Benedict (cREEHB) and weight-based (REEWB) equations with the Weir equation (REEW) using oxygen consumption (VO₂) and carbon dioxide production (VCO₂) estimated via the Fick principle. Methods: We included patients admitted to the intensive care unit (ICU) between January and August 2024, and computed cREEHB, REEWB (22.5 kcal/kg/day), and REEW. Agreement between methods was assessed through Bland-Altman analysis. Sensitivity and correlation analyses identified bias determinants. Multiple linear regression explored associations of REEW with VO₂, VCO₂, and cardiac output (CO). Results: The sample size consisted of 30 patients. No correlation was found between REEW and cREEHB (r=0.177, P=0.349) or REEWB (r=-0.006, P=0.975). Compared to REEW, cREEHB underestimated REE (mean bias, –47.9 kcal), while REEWB overestimated it (mean bias, +9.7 kcal). CREEHB bias was associated with sex, height, body surface area (BSA), VO2, and respiratory quotient (RQ); REEWB bias was influenced by actual body weight, body mass index, BSA, VO2, and RQ (all P<0.05). Multiple linear regression analysis showed that REEW was influenced by VO2 (P<0.001) and VCO2 (P<0.001) but not by CO (P=0.164). Conclusions: Predictive equations may not be interchangeable in ICU settings, leading to inaccurate metabolic assessments. Studies incorporating IC as a reference are needed to determine the most reliable approach for estimating REE and optimizing nutritional support in critical patients.

Background: Endovascular mechanical thrombectomy (EMT) can be performed with general anesthesia (GA) or using non-GA techniques. Several meta-analyses on the topic have reported discordant main outcomes. The aim of this retrospective single-center study was to analyze the relationship between clinical outcomes and anesthesiological management (GA vs. non-GA) in patients who underwent EMT for acute anterior ischemic stroke (AIS). Methods: We performed a propensity score-matched (PSM) analysis of patients who underwent EMT for acute AIS from January 2018 to December 2021. For PSM, we chose covariates influencing clinical decisions about anesthesiological management. Comparisons between groups were performed with the chi-square test for categorical variables and Student t-test or the Mann-Whitney U-test for continuous variables as appropriate. The relationships between anesthesiological management and clinical outcomes were analyzed using logistic regression, and results are reported as odds ratios with 95% confidence intervals. A two-sided P-value <0.05 was considered statistically significant. Results: From 194 observations (78 in the GA group, 116 in the non-GA group), after PSM, we obtained 70 data pairs. Both anesthesiological approaches resulted in similar rates of in-hospital mortality, 90-day functional independence, full recanalization, procedural complications, and intracerebral hemorrhage (ICH). Performing EMT with GA was unrelated to the in-hospital and 90-day death rates, 90-day functional independence, full recanalization rate, procedural complications, and ICH (P>0.05). Conclusions Anesthesiological management did not influence clinical outcomes of EMT for acute AIS. Physiological stability during EMT may impact outcomes more significantly than anesthesiological management. Further studies on this topic are needed.

Spinal cord injury (SCI) is a severe lesion comporting various motor, sensory and sphincter dysfunctions, abnormal muscle tone and pathological reflex, resulting in a severe and permanent lifetime disability. The primary injury is the immediate effect of trauma and includes compression, contusion, and shear injury to the spinal cord. A secondary and progressive injury usually follows, beginning within minutes and evolving over several hours after the first ones. Because ischemia is one of the most important mechanisms involved in secondary injury, a treatment to increase the oxygen tension of the injured site, such as hyperbaric oxygen therapy, should theoretically help recovery. Although a meta-analysis concluded that hyperbaric oxygen therapy might be helpful for clinical treatment as a safe, promising and effective choice to limit secondary injury when appropriately started, useful and well-defined protocols/guidelines still need to be created, and its application is influenced by local/national practice. The topic is not a secondary issue because a well-designed randomized controlled trial requires a proper sample size to demonstrate the clinical efficacy of a treatment, and the absence of a common practice guideline represents a limit for results generalization. This narrative review aims to reassemble the evidence on hyperbaric oxygen therapy to treat SCI, focusing on adopted protocols in the studies and underlining the critical issues. Furthermore, we tried to elaborate on a protocol with a flowchart for an evidence-based hyperbaric oxygen therapy treatment. In conclusion, a rationale and shared protocol to standardize as much as possible is needed for the population to be studied, the treatment to be adopted, and the outcomes to be evaluated. Further studies, above all, well-designed randomized controlled trials, are needed to clarify the role of hyperbaric oxygen therapy as a strategic tool to prevent/reduce secondary injury in SCI and evaluate its effectiveness based on an evidence-based treatment protocol. We hope that adopting the proposed protocol can reduce the risk of bias and drive future studies.